YALE JOURNAL OF BIOLOGY AND MEDICINE 1, 40-54 (1974)
The Pneumonic Plague Epidemic of 1924 in Los Angeles'
ARTHUR J. VISELTEAR
Department of Epidemiology and Public Health, Yale Medical School,New Haven, Connecticut 06510
Received August 13, 1973
In 1924, Los Angeles was the largest city in the West, the largest in land areaand the fifth largest city in the United States. Tourism, a land boom, emergingindustries, and a new harbor had made Los Angeles prosper. There were one mil-lion residents in Los Angeles and, whether native born or migrants seeking a for-tune or retirement haven, all enjoyed and extolled Los Angeles' one unchangingasset, its climate. With an average mean temperature in the mid-60's, an averagemean rainfall of less than 15 inches per year, and a smog free atmosphere, despitethe fact that there were more automobiles per capita in Los Angeles than in anyother city, Los Angeles was truly "the climatic capital of the world," or so claimedits Chamber of Commerce.
Nineteen percent of the residents in Los Angeles were foreign born. There wereapproximately 2,000 Chinese, 12,000 Japanese, and 22,000 Mexicans in Los An-geles in 1924; each group settling in different locations. Chinese residents settledin the Northeast section of the city; Japanese chose the Western part of town;and most of the Mexicans lived in an area which straddled the Eastern boundaryof the City of Los Angeles and the unincorporated territory of Los Angeles County.One Mexican community, bounded on the North by Alhambra Avenue, on the
West by Alameda Street, on the South by Macy Street, and on the East by theSouthern Pacific Railroad, may be found today located adjacent to the famoustourist attraction, Olvera Street. It was in this area that 28 Mexicans and two Cau-casians succumbed to pneumonic plague during a two-week outbreak from Octoberto November, in 1924.
In accordance with California statute, Dr. Walter Dickie, Secretary of the StateBoard of Health, transmitted a biennial report to Governor Friend W. Richardsonin which he noted in the preamble that the "management" of this particular out-break had represented "the most outstanding accomplishment" of California'shealth officers in the biennial period beginning 1924. Certainly pneumonic plagueis one of the most frightening epidemics known to man. Virulent and swift moving,
1 Presented at a meeting of the Beaumont Medical Club, Yale University School of Medicine,New Haven, Connecticut, December 15, 1972.
pneumonic plague, under proper conditions, disrupts and is capable of decimatinga community as few other epidemics can. It is understandable, then, that Dickieshould take pride in the accomplishments of those responsible for containing theepidemic. But Dickie's report, submitted almost two years after the outbreak, issusceptible to "historical drift." In order to evaluate more properly the validityand appropriateness of Dickie's encomium, this paper will chronicle and analyzethe events which occurred in Los Angeles, taking special cognizance of the social,administrative, and epidemiologic features of this last major epidemic of pneumonicplague in the United States.
I
On October 29, 1924, a physician requested an ambulance from the Los AngelesCounty General Hospital for Two Mexican patients critically ill of a malady whichhe could not definitely diagnose, but which he knew to be highly contagious sinceseveral others in the neighborhood were also affected with similar symptoms ofvery high fever and pains in the back and chest. The following day 13 other casesdisplaying the same symptoms were detected and subsequently admitted to the hos-pital, where they all developed signs of severe pneumonia, with bloody expectora-tion and marked cyanosis. It was during this day, after three of the 15 patientswho had been admitted had died, that the diagnosis of pneumonic plague was firstsuggested. The diagnosis was confirmed the following morning, but not made pub-lic, when the staff pathologist performed an autopsy and reported the presenceof gram-negative bipolar staining bacilli characteristic of plague in the lungs ofone of the deceased patients (1 ).
The United States Public Health Service and the State Board of Health firstlearned of the diagnosis somewhat indirectly. On October 31, telegrams were sentfrom the assistant superintendent of the hospital to federal and state authoritiesand to medical supply dealers inquiring where plague serum and vaccine couldbe obtained. On November 1, Benjamin Brown, the Public Health Service surgeonstationed in Los Angeles, having confirmed the information contained in the tele-gram, wired the Surgeon General in code as follows: "Eighteen cases ekkil [pneu-monic plague]. Three suspects. Ten begos [deaths]. Ethos [situation bad]. Recom-mend federal aid" (2). The Surgeon General immediately wired instructions toSenior Surgeon James Perry, stationed in San Francisco, to proceed to Los Angeleswhere he was to investigate quitely and be certain to keep the source of his informa-tion confidential. The Service, according to protocol and statute, did not wish toinvolve itself in state affairs unless officially invited or prescribed by law to doso (3).On the same day, Dr. William Dickie, secretary of the State Board of Health,
read in the morning newspapers that a "strange illness" had broken out in Los An-geles which had taken the lives of nine people and which threatened the lives ofeight others. The unnamed ailment, which was being investigated by city healthofficers, resembled pneumonia but "ran its course much faster." In a wire to Dr.Elmer Pascoe, acting health officer of the Los Angeles Health Department, Dickieinquired: "Kindly wire immediately cause of death of Lucena Samarano." Thereply was equally polite and laconic, "Death L. S. caused by Bacillus pestis" (4).
At 1:00 a.m., November 2, the Macy Street area, which included approximatelyeight city blocks and which housed approximately 2,500 Mexicans, was placedin quarantine by the City Health Department. All cases Qf illness occurring within
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ARTHUR J. VISELTEAR
the area were examined by health department physicians and suspicious cases sentto the County Hospital. The Los Angeles County Board of Charities providedseven-day rations for each household and sought to establish "cubicle isolation"for each house within the quarantine area (5). With the cooperation of the CatholicBoard of Charities, a Span-sh-speaking priest and social worker were placed in thearea to reassure and calm the anxious, residents. Public health nurses were alsosent to the area and directed to make a house to house inspection in an endeavorto locate other cases or contacts (6).
Arrangements were made with the County General Hospital to admit all personswho lived at addresses where pneumonic plague had occurred. A total of 114 con-tacts were admitted but none became ill with plague. Accordingly to the state epi-demiologist, the inhabitants recognized the highly contagious nature of the diseaseand avoided intimate contact (7). Early hospitalization of cases and self-imposedisolation were considered by the authorities as helping to contain the epidemic.Mention was also made of the fact that Mexicans, unlike Orientals, did not attemptto hide their dead. When seriously ill, they called a priest and, generally, wereprompt in securing aid. This one fact, it was believed, eliminated many of the diffi-culties encountered by health officials who had been responsible for controllingthe San Francisco outbreaks of the early 1900's (8).Upon admission to the hospital all suspected plague cases had their charts flagged
with a notation which read, "pneumonic plague," "suspected pneumonic plague,""suspected bubonic plague," or "individual isolation." Nurses, doctors and orderliesresponsible for the care of suspicious cases or contacts protected themselves witha rather simple but ingenious mask device made of a pillow slip and celluloid,gowns which fitted closely about the neck, and rubber gloves.
The plague serum which had been requested by the Los Angeles County GeneralHospital and the acting health officer of the City Health Department arrived inLos Angeles on November 5, but records reveal that it was secured in time tobe used in only one case. Moreover, there seems to have been some doubt expressedin the reports that it would have been effective in cases of pneumonic plague (9).Mention is made in the records, however, of the use of mercurochrome and thesubsequent recovery of two plague patients who received inoculations of this sub-stance (10). The plague serum predictably received prominent attention by thepress and was played up in the promotional literature of the company that producedit. In the house organ of the Mulford Laboratories, the affair was dramaticallydepicted:
"Science has discovered a serum that will stop the Swath of Death and save
the lives of thousands. Los Angeles calls for help and in less than 36 hours the vialsof serum were brought to the front lines where the battle is on against the Terror.That's the thriller. That's 20th century truth. That's the news that warms the heartrather than chills the marrow. That's the sort of stuff that makes you glad you'reliving and inspires you to be proud of your kind, of your country and of theprosperity and enterprise which have backed experiment to the point of achievementwhere such miracles are possible. And you are part and parcel of the organizationthat produced this thriller" (11). (See figs. 1 and 2).
Additional measures were taken by authorities which appear prominently in thereports. All health care facilities, such as emergency rooms and free clinics, were
instructed by the State Board to report any illness of a suspicious nature and the
42
THE PNEUMONIC PLAGUE OF 1924
FIG. 1
Los Angeles County Medical Society, on the urging of the State Board, assembledin special session to hear lectures on the etiology, signs, symptoms, and therapyof the three varieties of plague (12).
City health officers who released the story already had a confirmed diagnosisof pneumonic plague but chose for obvious reasons to refer to the disease, fromNovember 1 to November 5, as the "strange malady," "pneumonia," "virulentpneumonia," or "malignant pneumonia." Not until November 6, when the epidemicappeared to have run its course, did Los Angeles newspapers refer to the diseaseproperly as pneumonic plague and even then justified their evasion by adding thatpneumonic plague was the 'technical term" for "malignant pneumonia" ( 13 ).
43
44 ARTHUR J. VISELTEAR
SY^LMUA1 t*Y .
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.:::: ..:
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FIG. 2.
The New York Times and the Washington Post, however, were quick to headlinethat pneumonic plague had erupted in Los Angeles ( 14). Indeed, the news blackoutwas confined to Los Angeles as most major California newspapers reported theepidemic correctly and, in Oakland, the State Board of Health even chose to discuss
on
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1: OrA
THE PNEUMONIC PLAGUE OF 1924
the epidemic on its weekly radio show. Unabashedly referring to pneumonic plagueas the "celebrated black death of the 14th century, in which one-quarter of theEuropean population was destroyed," the narrator proceeded to discuss in layman'sterms the three types of plague, bubonic, pneumonic, and septicemic, the role ofthe flea and the rat, and describe in detail the measures that officials had takento contain the epidemic in Los Angeles. Despite the virulence of the pneumonicvariety and the potential danger, concluded the health officer, pneumonic plaguefortunately did not flourish in dry climates, such as Los Angeles, where there iscomparatively little moisture in the air (15).
In Washington, the Public Health Service's Sanitary Board met to discuss thesituation as reported in the Los Angeles dispatches. It was the opinion of the Boardthat a ground squirrel and rat survey be made in Los Angeles and neighboringcounties, and especially of Los Angeles' harbor in San Pedro, to determine theextent of infection. The Board believed that Senior Surgeons Perry and Wayson,both seasoned and experienced officers, could be relied upon to carry out all neces-sary procedures and that no detailed instructions needed to be sent to them (16).
II
On November 3, Perry, accompanied by Surgeon Newton Wayson, arrived inLos Angeles and met with Dr. Dickie, and with representatives of the City andCounty Health Departments and the Chamber of Commerce in the office of themayor. It was agreed that all plague control work was to be coordinated by anAdvisory Committe composed of Dickie, Perry, and representatives of the Cityand County Health Departments and the County General Hospital. In Dickie'sBiennial Report he notes that "all control work" was placed under his direction,but the records reveal that formal control was not transferred to the State untilNovember 21. On the 3rd, as a result of the meeting establishing the AdvisoryCommittee, it is difficult to determine just who was in charge since jurisdictionaldisputes were evident from the start, compounded by the fact that only a few weeksprior to the outbreak, Los Angeles' Health Officer, Dr. Luther Powers, had diedand the City only recently had appointed an acting health officer, Dr. ElmerPascoe, in his place (17).
The Advisory Committe on the 3rd issued a plan of operation, which includedthe following.
1. Quarantine2. Restriction of movement within the quarantine area3. House to house inspection4. Hospitalization of all contacts5. Post mortems on all deaths occurring in the quarantine area6. The establishment of a bacteriological laboratory7. Hiring a force of men responsible for trapping, poisoning and rat proofing
of buildings8. Disinfection of households by petroleum spray9. Tagging of all rats, mice and squirrels by location
10. Eradication of ground squirrels
On the same day, the 3rd, Perry wired Acting Surgeon General White thatDickie, representing the State Board, appeared to be in charge and that Public
45
ARTHUR J. VISELTEAR
Health Service personnel were serving in an advisory capacity only. Perry believedthat the community could finance the work and that no additional Public HealthService representatives were needed at that time (18). White unfortunately did notreceive Perry's cable and sent a rather sharply worded wire which probably hadbeen prompted by the banner headlines that appeared in the Washington papers,inquiries from other state health officials and the Secretary of the Treasury, andWhite's own untenable position as acting surgeon general in Hugh Cumming'sabsence. White wrote as follows.
"Perry. Your failure to report on situation has created very unfavorable impressionfor the Service. . You will immediately telegraph full report. . . . Other Statesare keenly interested in what is being done to protect them. . . . Bureau dependson you for information and strict attention to this order is enjoined. You will explainin your first telegram why you have delayed reporting and give your Los Angelesaddress ( 19).
Perry sent White his address in a cable mailed on the 5th and, later that day,sent another cable describing the control measures taken by the Advisory Commit-tee (20).
Between the time of the original reprimand to Perry on the 3rd and November6, Perry continued to wire factual information to Washington. On the 7th, however,he wrote a three-page letter in which he justified his actions and expressed hisown dissatisfaction with White's apparent lack of confidence in his ability. Perrywrote that it was he who had recommended the establishment of the Advisory Com-mittee and sought to coordinate eradication measures; that neither the city northe state wanted the Public Health Service to take charge of the operation, espe-cially since Dickie, believing he was filling the vacuum created by Power's death,was "keenly desirous" of taking complete control himself; and that the delay inresponding to Washington had been further justified since there was some doubtthat pneumonic plague actually existed! The surgeon who accompanied Perry toLos Angeles, Dr. Newton Wayson, was an expert in identifying plague organismsand, upon arriving in the city, went promptly to the hospital to confirm the originaldiagnosis. Wayson subsequently reported to Perry that "a few" bipolar organismswere visible on the prepared slides but since they had been so poorly stained andsince there had been no animal inoculation, he believed, as did the state bacteri-ologist, W. H. Kellogg, who possessed similar impeccable credentials, that therewas not sufficient bacteriologic evidence upon which to make the diagnosis of plague(21). On the next day, however, they prepared their own slides from the lungsof another victim and were able to confirm the disease bacteriologically. Althoughboth men may have been bacteriological purists, it appears, given the overwhelmingclinical evidence, that neither wished to place himself in a potentially vulnerableposition based on a junior pathologist's poorly prepared slides. With so much atstake only their own preparations would satisfy them.
Perry concluded his letter to White with a statement that he believed that theBoard should have had confidence in his ability to judge matters and, moreover,that he had followed accepted Board protocol and procedures. He in no way feltthat his actions were responsible for any embarrassment experienced by White orthe Board. Stopping short of requesting an apology from White, he noted thatsubsequent daily reports would follow as soon as accurate information had beendigested and analyzed (22).
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Whether or Inot Perry's letter affected White is not known since Hugh Cummingreturned to Washington and resumed his post as Surgeon General. The letter obvi-ously had a cathartic affect on Perry, but too much was happening in the earlydays of November for Perry to rest easy. Dr. Dickie, for whom Perry earlier hadexpressed high regard, soon became the object of Perry's attention and the cor-respondence from November 7 to mid-December reveals a new conflict: Perry vsDickie.
In a telegram sent to Washington on November 10, Perry conveyed certain confi-dential "personal impressions" about the management of the epidemic. Dickie andother city and state health officers believed that the epidemic eventually wouldbe traced to infected squirrels, as it had during the Oakland pneumonic plagueepidemic of 1919 (23). If such was the case, then the epidemic, if localized bycareful quarantine, would be over when the last case was isolated in the hospital.Prompt containment of the epidemic, wrote Perry, would work to the credit ofDr. Dickie, whose term had expired and reappointment not yet been made. Perrymight have cited the additional fact that Dr. Pascoe, acting city health officer,was also interested in a favorable press since he, too, was in line for promotion.Indeed, there seemed to be developing a growing friction between the three prin-cipal players, Dickie, Pascoe and Perry (24).
Perry eventually won Dickie over to his position that the outbreak in the MacyStreet District had been the result of rat and not squirrel infection and Dickie subse-quently emphasized the importance of an extensive and well financed campaignof rat eradication before the Los Angeles City Council, of which more will besaid shortly. The issue that Perry pressed in his letter of the 10th, however, wasthat neither the state nor the city had tne personnel to carry on effective controlmeasures. Dickie already had stripped his office in San Francisco and no longerhad available personnel for duty in case other communicable diseases became epi-demic. W. H. Kellogg, the state's only experienced plague bacteriologist, was divid-ing his time, as was Dickie, between San Francisco and Los Angeles. Moreover,eradication measures would be very extensive since there were many unsanitaryareas in Los Angeles, few houses that were adequately rat proofed, and there ap-peared to be a heavy rat infestation. Sooner or later, prophesied Perry, the Servicewill be asked to take charge of the work (25).On November 14, Perry spelled out another area of potential friction; namely,
that his association with Dr. Dickie might lead some to conclude incorrectly thatthe Service had a great deal to do with the campaign, whereas, in fact, it had noth-ing to do with regard to implementation. Dickie freely sought Perry's opinion, asdid Dickie's staff, which only further compromised Perry's and the Service's posi-tion. If the campaign succeeded, Perry wrote, the State Board of Health wouldreceive the credit; but if the work did not meet with success, the Service wouldbe held responsible. Perry recommended, as a way out of the predicament, thatthe Board issue a press release that they had cooperated with the State Boardof Health by loaning experienced officers for the formulation of the control anderadication campaign, but that this having been done, the execution of the planrested solely in the hands of the State Board of Health (26).
Perry and Dickie maintained a polite but remote relationship at this time, whichwas sweetness and light compared to Dickie's relationship with the acting cityhealth officer, Dr. Pascoe. On the 21st, Perry informed Washington of the powerstruggle that had developed between Pascoe and Dickie as to who would be respon-
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ARTHUR J. VISELTEAR
sible for the rat eradication campaign. Despite his earlier reservations about theresources of the state, Perry recognized that it was in a better position to run thecampaign than the city because the state would be less susceptible to the inevitablepressures from the City Council and the Chamber of Commerce, who might wishto end the campaign prematurely in order to restore as soon as possible Los Ange-les' salubrious image (27). At least the state, wrote Perry, recognized the gravityand the necessity of a long campaign (28). But there is no doubt that Perry be-lieved he was choosing between the lesser of two evils.
If Perry was absolutely impartial, he would have recognized earlier the importantrole played by Dickie. Perry, for example, had not been present on November15 when Dickie addressed a meeting attended by the mayor, the City Council andrepresentatives of the Chamber of Commerce. Before this assembly, Dickie warnedthat the plague would bring financial ruin to Los Angeles if prompt action wasnot taken. "There is no disease known that has such an effect upon the businessworld as plague," he said. The harbor will be quarantined, boats will not be per-mitted to dock, goods will rot in warehouses, and businesses will go bankrupt aslong as there is even the suspicion of plague. It is imperative he added, that ratsbe eradicated and houses be rat proofed. The entire Macy Street area and areaslike it in the city should be condemned and restored so that they would be fitfor human habitation. Dickie concluded that the cost of the clean-up and eradica-tion campaign would be $500,000. Nothing less will restore the confidence of theworld in Los Angeles than an expenditure of such magnitude, he concluded (29).It was the threat of a quarantined port, then, that had convinced the Council toappropriate $250,000, half the sum requested by Dickie, for plague control. Itshould be of no surprise that most of the trapping and rat proofing operationsinitially took place in the harbor and not in the Macy Street district. Shacks inthe area were indeed condemned and demolished, and dwellings fumigated andrat proofed but most of the early effort was reserved for the harbor district. Ironi-cally, the first plague rat in the harbor area was not found until December 29,trapped on a hog ranch located four miles from the harbor. So intimidated wasthe City Council and the Harbor Commission that the ranch was completely demol-ished and relocated 10 miles from the harbor (30).On November 28, a meeting arranged by Surgeon General Hugh Cumming, was
held in Los Angeles. In attendance was Surgeon Richard Creel, who was Cum-ming's personal representative, and Drs. Perry and Dickie. Creel's letter to Cum-ming presented highlights of the meeting and brought out the following points. First,Dickie believed that the state could handle the eradication program and the Serviceshould do nothing to inhibit the state's operation. If the state found itself in diffi-culty, however, Dickie would be honor bound to let the Service know before March4, which was the date Congress would adjourn and therefore the last day the Servicecould secure necessary funds to take control of operations. Second, that Dickiehad planned to capitalize on the epidemic by seeking additional funds from theCalifornia State Assembly. The state legislature for years had not heeded the StateBoard's request for increased appropriations, due largely to the antagonistic attitudeof the governor. Third, since Dickie himself had expressed concern about the lackof a qualified bacteriologist, he was asked to turn over the laboratory operationto the Service. Creel believed Dickie might apply to the Service for a bacteriologistto work on a temporary basis, but Dickie finessed the question. In the back ofhis mind he feared the proverbial camel sticking its head under the tent. For reasons
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THE PNEUMONIC PLAGUE OF 1924
that were perhaps both chauvinistic and pragmatic, Dickie subsequently was ableto bring Professor Karl Meyer of the University of California into the picture. Hemight have reasoned as follows. The state should have complete control; Meyeris a professor at the state's own University; the legislature would be pleased becauseits own employees will be in charge of key operations; their pleasure might bereflected in larger appropriations to the State Board of Health. Meyer, incidentally,was agreeable to the plan for reasons of his own. According to Wayson, he sawhimself as the head of a new School of Public Health at Berkeley, which was beingproposed at that time before the state legislature (31). Fourth, the Service in noway could wrest control from the state since the Service was bound by the 1893Act authorizing the president ". . . to adopt such measures as in his judgmentshall be necessary to prevent the introduction or spread of diseases, and may detailor appoint officers for that purpose; but only in the event that the state or themunicipal authorities shall fail or refuse to enforce its own rules and regula-tions . . ," which Los Angeles and the state had not done. And fifth, quarantinewas justifiable so long as rodent plague existed in Los Angeles. This latter pointwas to be raised whenever the campaign seemed to falter (32).
Although Creel seemed sanguine after the meeting, Perry remained skeptical.His interpretation differed markedly from Creel's. The conference, he wrote, was"without tangible result." Dickie had not accepted the Service's offer to take overhis laboratory, which both Perry and Wayson believed to be central to the eradica-tion campaign. Moreover, the fact that Dickie had admitted he might be able tocapitalize on the epidemic to increase the state's appropriations to the State Boardof Health was interpreted by Perry as indicating the baseness of Dickie's motives(33).
Perry continued in this critical vein in succeeding weeks. He repeatedly returnedto points he had made earlier; namely, that the Service representative in Los Ange-les be merely an "observer" and not serve in an advisory capacity, that Dickie'sresources were too limited to mount an effective eradication campaign and thatDickie's motives were based primarily on ambition.On December 6, Cumming authorized Perry, Creel and Wayson to serve as a
Committee of Three to prepare a formal report on the adequacy of the plague eradi-cation measures for official Service use (34). The committee completed its reporton December 11 and transmitted its finding to Cumming. Despite Creel's moderat-ing influence, the report seemed more a reflection of Perry's original positions:that Dickie was a marginal and absentee administrator; that the supervision of thecampaign was casual and periodic and suffered from the lack of a sustained effort;that there was precious little cooperation and uniformity of procedure; and thatthe scope, practice and efficiency of the field and laboratory work were inadequate.In view of such conclusions, the Committee of Three recommended that the Servicedisassociate itself from the campaign and issue Perry's earlier statement, that theService in no way approves of the State's program. An added sentence, somewhatgratuitous under the circumstances, is indicative of Perry's opinion of Dickie: "Itis apparent that Dr. Dickie does not appreciate the gravity of the situation or theimportance of enlarging the scope of the campaign or of increasing the efficiencyof operations. This is evidenced by his nonacceptance of the proffered concreteService aid" (35).Cumming now had no other recourse than to quarantine Los Angeles' port in
San Pedro. On December 22, he sent a letter to all medical officers in charge of
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ARTHUR J. VISELTEAR
quarantine stations declaring San Pedro, and the ports of Oakland and New Orleans,where plague also had become epidemic, as "plague infected." All vessels departingfrom these ports were required to fly a quarantine flag, await inspection upon arriv-ing at quarantine, and present a port sanitary statement, issued by the medicalofficer in charge of the outgoing quarantine station at each of the ports mentioned(36).
Dr. George Ebright, director of the State Board of Health, was dumbfoundedat the order, but Dickie seemed unperturbed. He assured Ebright that his programhad been effective and asked Ebright to invite Cumming to Los Angeles so thathe might see for himself how wrong Creel, Wayson, and Perry had been (37).
Others, however, reacted predictably. The chairman of the Los Angeles Cham-ber of Commerce, for example, in a letter to Congressman Robert Armstrong, be-lieved the Surgeon General's promulgation was "rank discrimination" since the con-ditions in Los Angeles were in no way analogous to Oakland or New Orleans.In those ports, he explained, rodent plague was actually on the waterfront, whereasin San Pedro trapping operations had revealed a catch of astonishing few rats.Moreover, he wrote, the harbor was located 22 miles from the site of the epidemic,being connected to the municipality by a narrow, railroad track wide strip of landthat passed through sparsely settled regions. Overlooking the fact that freight trainsand laborers made many round trips between the city and the harbor, the letterconcluded by assuring Armstrong that the Committee of Three's report was "ridicu-lous" and "without foundation in fact." He urged that every effort be made inWashington to remove the quarantine, "as shipping was being seriously affected"(38).
After the new year, Ebright followed Dickie's advice and invited Cumming toLos Angeles to acquaint himself personally with the rodent situation (39).Cumming was agreeable and planned to come immediately. "I have always feltthat if we could get together we could straighten out what appeared to be a ratherawkward situation. . My only purpose has been to assist the state in gettingrid of this condition quickly," Cumming wrote in reply (40).Cumming did indeed meet with state and local officials but appraised the situa-
tion in the same terms as had Perry. Dickie assured Cumming that he would doall in his power to correct the items noted in the Committee of Three's reportand that the Service would be called in before March if needed. Cumming returnedto Washington, but despite Dickie's assurances appeared to be as frustrated as Perryhad been. He also believed that the Service should take responsibility for the eradi-cation program, and for a reason precisely similar to that Perry believed had moti-vated Dickie: that the Service would be better able to plead its case before Congres-sional Committee for increased appropriations in order to protect the nation fromdread diseases such as pneumonic plague. In subsequent letters Cumming lamentedthe fact that this had been the only epidemic for which the Service had not beeninvited by local authorities to take charge (41). It was more than being left outadministratively that concerned Cumming; it was being left out of the dollarsweepstakes.
During the early months of 1925, the city and the state continued their feud.Los Angeles had appointed a new health officer, Dr. George Parrish of Oregon,and letters were written to Cumming wondering why so qualified a man as Parrishshould not be entrusted with the eradication campaign (42).
Cumming's replies were not satisfactory to city officials and they proceeded to
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THE PNEUMONIC PLAGUE OF 1924
attempt to discredit the state's program by intimating that the state had misappro-priated city funds for rat control. The City Council then passed an ordinance en-abling Parrish to take over the program from the state so as to insure, in theirwords, proper expenditure of city funds (43). But once this was done, the Council'sFinance Committee immediately reduced Parrish's budget which severely impededthe eradication program (44). This is what Perry had feared all along would hap-pen if the city took control. When Parrish, Dickie, and the Service representativelearned of this maneuver, they petitioned the Council, not to restore the originalbudget, but rather to request that the Public Health Service be given control ofthe program once and for all. Some seven months after Perry had surmised thatthe Service would be called in, Mayor George Cryer sent a letter to President CalvinCoolidge requesting that the Public Health Service be given responsibility for theplague eradication program in Los Angeles (45). Within a week of the request,in July, former Surgeon General Rupert Blue, who had been in charge of the firstplague control program in San Francisco in the early 1900's was recommissionedas an assistant surgeon general and sent to Los Angeles to take charge (46).Blue initiated an immediate rat control campaign which was to cost the city andcounty of Los Angeles, the County Horticulture Commission, and the state sumsin excess of $400,000. In addition, property owners were to spend over $2,000,000to comply with new rat proofing ordinances passed at Blue's insistence. Despitethe fact that the mortality rate was relatively small, the amount spent to containthe epidemic was indeed considerable.
III
Interestingly, but perhaps not surprisingly, Dr. Dickie, in his Biennial Reportwritten in 1926, makes no mention of Blue's role in the campaign; nor does hemake mention of Senior Surgeons Perry and Wayson. Instead, Dickie dwelt onthe usual and customary epidemiological features of the epidemic, singling out onlythe work of the state epidemiologist who traced the epidemic to a 55-year oldMexican who had fallen ill on October 1, and his daughter, both of whose symp-toms had been misdiagnosed. The daughter's "lobar pneumonia," from which shesuccumbed on October 5, was actually a secondary plague pneumonia and thefather's "veneral bubo" was bubonic plague. When the father was examined onOctober 31, pus was still draining from a sinus at the site of the bubo. Microscopicexamination revealed characteristic plague organisms and animal diagnosis verifiedthe diagnosis of bubonic plague. Both cases were believed to be the origin of theseries of cases of pneumonic plague in the Macy Street District.
In the conclusion to his report, Dickie wrote this final sentence: "Local, stateand federal officials who have engaged in plague work in California may view withsatisfaction and look back with some degree of pardonable pride on the resultsaccomplished [here]" (47). One may legitimately ask "whose satisfaction" and"whose pardonable pride?" Certainly Dr. Pascoe, acting city health officer ofLos Angeles had not been satisfied, since he was passed over for promotion andeventually discharged by the man hired as health officer, Dr. George Parrish. Norcan one say that Senior Surgeons Perry and Wayson experienced "pride," pardon-able or otherwise, since they could not convince state and local officials to givethe Service control of the eradication program from the start. Surgeon GeneralCumming's quarantine order, based on the Committee of Three's report, was alsonot the proudest day for the Service since one may question his motives as well.
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52 ARTHUR J. VISELTEAR
No infected rats had been found in the harbor when Cumming had declared theport "plague infected" on December 22, despite the fact that trapping operationshad begun on November 5. The potential for an outbreak to occur in the port, theneed to protect shipping and abide by international sanitary treaty obligations, andCumming's own vulnerability, doubtless prompted the order, but it would be diffi-cult not to assume that the Service also needed a favorable press to maintain itsown image as the health guardian of the nation, a press which would be viewedfavorably by Congressional Committee at annual budget sessions. One even won-ders if Dr. Dickie believed his own conclusions, for he had been discredited byboth the Service and the Los Angeles press. Yet among his peers within the state,Dickie emerged as the hero. Dr. James Pomeroy, Los Angeles County healthofficer, in 1926 praised Dickie's work on behalf of a beleagured city (48). And,in 1927, when the State Board of Health evolved into a Department of PublicHealth, Dickie was appointed its first full-time director.
If we return to evaluate Dickie's encomium, "that the management of this epi-demic represented the most outstanding accomplishment of California's healthofficers," we appreciate that much more was involved and at stake than the officialreports reveal. Interpreted in this way, Dickie's statement is gratuitous at best andat the very least misleading, albeit understandably so.
REFERENCES1. Bogen, Emil. "The Pneumonic Plague in Los Angeles," Calif. & West. Med. 23, 175-176
(1925).2. Benjamin Brown to Surgeon General, 1 November 1924. USPHS/LA 0425-183. The
papers of the U.S. Public Health Service are stored in the National Archives. Iam indebted to Jane F. Smith, Director, Social and Economics Records Division,National Archives, for locating pertinent documents in this vast collection.
3. Surgeon General to James Perry, 1 November 1924, Ref. (2). Confirmed by the Secretaryof the Treasury, Mellon to Perry, 3 November 1924. USPHS/LA 0425-32.
4. Walter Dickie to Elmer Pascoe, 1 November 1924, and Pascoe to Dickie, 1 November1924. Ref. (3).
5. Minutes, Board of Supervisors, County of Los Angeles, 10 November 1924, 95, 113.See also L. E. Lampton (Clerk, County Board of Supervisors) to W. H. Holland(Superintendent of Charities) 6 November 1924. Board of Slupervisors, 180/OD 1878.1H.
6. State Board of Health, 'Twenty-ninth Biennial Report of the State Board of Healthof California for the Fiscal Years from July 1, 1924 to June 30, 1926." Sacramento,California State Printing Office, 1926, p. 11.
7. California State Board of Health, "Pneumonic Plague, Report of an Outbreak at LosAngeles, California, October-November, 1924. Special Bulletin No. 46." Sacramento,California State Printing Office, 1925, p. 12.
8. "Biennial Report," Ref. (6), p. 10. For information about earlier outbreaks in Californiasee: Blue Rupert, "The Underlying Principles of Anti-Plague Measures," Calif. St.J. Med. 6, 271-277 (1908) and his "Statistics of Plague in California," Public HealthReports 23, 593 (1908) and "Bubonic Plague Control in California in 1903 . . . ,"Calif. & West. 40, 363-365 (1934); Hassler, W. C., "The continuance of plaguein San Francisco," Calif. St. J. Med. 6, 7-10 (1908); McCoy, G. W. "Plague preventionworks; Anti-plague measures in California," Public Health Reports 25, 585-589 (1910);Evans, G. H. "Plague epidemics in San Francisco," Calif. & West. Med. 50a 24-25(1939), and Link, Vernon B. "A History of Plague in the United States of America."Public Health Monograph No. 26, Washington, G.P.O., 1955.
9. G. W. McCoy to Phoebus Berman (Assistant Superintendent, Los Angeles County GeneralHospital), 3 November 1924. USPHS/LA 0425-183.
10. White (acting Surgeon General) to J. C. Perry, 12 November 1924. USPHS/LA 0425-183.See also Bogen, Ref. (1), p. 175.
THE PNEUMONIC PLAGUE OF 1924 53
11. The Spark Plug, 13 November 1924. Weekly newsletter published by Mulford BiologicLaboratories, Philadelphia, Pa. Mulford was eventually absorbed by Merck Sharp& Dohme. I am indebted to Barbara L. Burke, Associate Librarian of Merck Sharp& Dohme Research Laboratories for this and other documents pertaining to Mulford'splague serum.
12. Biennial Report, Ref. (6), pp. 15-20.13. L. A. Times and L. A. Examiner, 2-6 November 1924.14. N.Y. Times and Washington Post, 2 November 1924.15. "Plague and its prevention. Radio talk, Radiocasted from Station KGO, Oakland, 3
November 1924." California State Board of Health Weekly Bulletin 3, 158 (1924).16. Minutes of Bureau Sanitary Board Meeting attended by Acting Surgeon General and
Senior Surgeons White, McCoy, Lloyd, Stimson, Draper, and Guthrie. USPHS/LA0425-32.
17. L. A. Examiner and L. A. Times, 4 November 1924. See also Perry to Surgeon General,7 November 1924. Ref. (3).
18. Perry to Surgeon General, 4 November 1924. Ref. (3).19. White to Perry, 4 November 1924. Ref. (10).20. Perry to Surgeon General, 5 November 1924. Ref. (3).21. Perry to Surgeon General, 5 and 7 November 1924. Ref. (3).22. Perry to Surgeon General, 7 November 1924. USPHS/LA 0425-183.23. Ref. (22). For further information on the Oakland epidemic see, California State Board
of Health. Pneumonic Plague, Report of an Outbreak in Oakland August-September,1919, by Walter Kellogg. October 1, 1919 Sacramento, State Printing Office, 1919and Twenty-Sixth Biennial Report of the State Board of Health. Sacramento, StatePrinting Office, 1921, pp. 12-13.
24. Perry to Surgeon General, 29 November 1924. USPHS/LA 0425-183.25. Perry to Surgeon General, 10 November 1924. USPHS/LA 0425-32.26. Perry to Surgeon General, 14 November 1924. Ref. (25).27. Los Angeles was indeed smarting under the adverse publicity it had received. A year
after the epidemic one author gave an explanation for the attack. The City of LosAngeles, he wrote, had spent millions to establish itself in the minds of the publicas an "earthly paradise." It was natural for city fathers to suppress news whichmight damage the city's reputation. Thus, when the story leaked out, mid-Westernand Eastern newspapers, embittered by long years of smug and abusive propaganda,published the Los Angeles dispatches with banner headlines. These regions, the articlecontinued, had suffered in silence while every eastern thunderstorm had been playedup in Los Angeles' newspapers as a "death-dealing tornado" and every snow flurrylabeled, "Scores Die in Eastern Blizzard." Now it was their turn. See Knox, W. B.Los Angeles's campaign of silence. The Nation 121, 646-647 (1925).
28. Perry to Surgeon General, 21 November 1924. USPHS/LA 0425-32.29. Minutes, Conference on Sanitary Conditions, November 15, 1924. Los Angeles City Coun-
cil, 1924, 1577:7340, n.p.30. Biennial Report, Ref. (1), p. 15.31. N. E. Wayson to J. C. Perry, 2 December 1924. USPHS Marine Hospital Records,
"Los Angeles-Administrative." This file folder is located in the Communicable DiEeaseCenter, San Francisco Field Station, Public Health Service.
32. R. H. Creel to Surgeon General, 28 November 1924. USPHS/LA 0425-183.33. Perry to Surgeon General, 29 November, 4 and 11 December 1924. Ref. (32).34. Surgeon General to Perry, 6 December 1924. Ref. (32).35. Perry to Creel, Wayson to Surgeon General, 11 December 1924. Ref. (34).36. Surgeon General to Medical Officers in Charge, U.S. Quarantine Stations, Collectors
of Customs, and others concerned, 22 December 1924. USPHS/LA 0425-183.37. Dickie to Cumming, 3 January 1925. USPHS/LA 0425-32.38. A. G. Arnoll to Robert Armstrong, 3 January 1925. Ref. (37).39. Ebright to Cumming, 7 January 1925. Ref. (37).40. Cumming to Ebright, 15 January 1925. Ref. (37).41. Cumming to E. W. Nelson (Chief, Bureau of Biological Survey, Department of Agricul-
ture), 7 January 1925. USPHS/LA 0425-183, and to Roy Knox (Director, EfficiencyDepartment, City of Los Angeles), 28 April 1925. Ref. (37).
54 ARTHUR J. VISELTEAR
42. Knox to Cumming, 17 April 1925. Ref. (37).43. Cuming to Knox, 28 April 1925. Ref. (37).44. L. A. Times, April 30, 1925.45. George Cryer to Calvin Coolidge, 27 June 1925. USPHS/LA 0425-183.46. Rupert Blue to George Ebright, 2 July 1925. USPHS/LA 0425-32.47. Bieninial Report, Ref. (1), p. 23.48. Discussion following paper presented by Walter Dickie entitled, "Plague in California,
1900-1925," a reprint from the Proceedings of the Conference of State and ProvincialHealth,Authorities of North America, 1926, p. 66.
